Prospective studies on post ERCP/ES acute pancreatitis. Sied lombardia procop group reported by
E. MasciG TotiG. MinoliFrancesco CosentinoA. MarianiStefano GueriniErika MeroniGabriele MissaleA. LomazziA. PradaU CominC. CrostaA. Tittobello
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[Objective] To explore the therapeutic effects of ERCP and EST on acute relapsing pancreatitis.[Methods] 31 patients with acute relapsing pancreatitis during October 1999 to 2006 were enrolled in this study.All of them took ERCP,ENBD,EBD or EST.The effects of these methods were observed.All the patients were followed up for 6 months to 2 years.[Results] Small pathological changes were found in 14 cases,which accounted for 45.16%.No relapse was found within the follow up period.[Conclusion] ERCP and EST are effective in treating acute relapsing pancreatitis.
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Previous pancreatitis is a definite patient-related risk factor for pancreatitis after endoscopic retrograde cholangiopancreatography (post-ERCP pancreatitis: PEP). However, the effects of differences in the history of PEP and acute pancreatitis on the occurrence of PEP have not been fully investigated. We examined the relationship between previous PEP or previous acute pancreatitis and procedural factors associated with PEP.Clinical data on 1,334 consecutive patients undergoing ERCP between April 2006 and June 2010 were collected. A multivariate logistic regression analysis was conducted to assess the relationship between PEP and the cannulation time (<15 min vs. ≥15 min) or total procedure time (<30 min vs. ≥30 min) according to previous pancreatitis (previous PEP: pPEP or previous acute pancreatitis: pAP), with adjustments for clinical characteristics.Longer cannulation times (≥15 min) correlated with the occurrence of PEP in the pPEP group (OR=2.97; 95% CI=1.10 to 8.43, P=0.03) and in patients without previous pancreatitis (non-preP group) (OR=2.43; 95% CI=1.41 to 4.14, P= 0.002), but not in the pAP group (OR=2.78; 95% CI=0.50 to 22.42, P= 0.25). In contrast, longer procedure times correlated with the occurrence of PEP in the pAP group (OR=3.93; 95% CI=1.11 to 16.5, P= 0.03), but not in the pPEP group (OR=2.79; 95% CI=0.92 to 9.18, P= 0.068) or non-preP group (OR=0.71; 95% CI=0.39 to 1.24, P= 0.23).A higher risk of PEP with previous PEP was associated with longer cannulation times, whereas a higher risk of PEP with previous acute pancreatitis was associated with longer procedure times.
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Pancreatitis is a known complication of endoscopic retrograde cholangiopancreatography (ERCP). Our aim was to assess the prevalence and severity of ERCP-associated pancreatitis using established criteria.Retrospective review of patients younger than 18 years undergoing ERCP complicated by post-ERCP pancreatitis defined by the 1991 consensus statement. Patients with chronic pancreatitis were studied separately using modified criteria. Risk factors for post-ERCP pancreatitis were analyzed.Three hundred forty-three ERCPs were performed in 224 patients. Two hundred seventy-six ERCPs were performed in patients without chronic pancreatitis, 7 of which were complicated by post-ERCP pancreatitis (prevalence 2.5%). Patients undergoing diagnostic-only ERCP were less likely to develop post-ERCP pancreatitis (P<0.01). Sixty-seven procedures were performed on patients with chronic pancreatitis; 10 developed postprocedure pain requiring or prolonging hospitalization (prevalence 14.9%). Pancreatic duct stenting was a risk factor for post-ERCP pain in this subset of patients (P=0.02).The prevalence of post-ERCP pancreatitis is low-2.5% excluding patients with chronic pancreatitis and 4.96% overall. Therapeutic procedures and the presence of chronic pancreatitis are risk factors for post-ERCP pancreatitis.
Pancreatitis, chronic
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Introduction: Pancreatitis is the common complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Diagnosing the risk factors for post-ERCP pancreatitis is important in the management of patients. In this study, we evaluated possible risk factors of post-ERCP pancreatitis among Iranian patients. Materials and methods: In this retrospective study, 708 diagnostic and therapeutic ERCPs performed in Imam Reza hospital, Tabriz, Iran between April 2011 and September 2012 were studied. The rate of post-ERCP pancreatitis and possible risk factors were evaluated using a multivariate regression analysis. Results: Post-ERCP pancreatitis occurred in 4.58% of cases. Unsuccessful ERCP (27% vs. 12.4%, p=0.02) and Body mass index (23.48±3.02 vs. 26.11±4.70 kg/m2, p=0.002) were significantly higher in patients with pancreatitis compared to those without pancreatitis. Regression analysis showed that only lower body mass index was the independent risk factor for post-ERCP pancreatitis occurrence (OR=1.341, CI95%[1.003-1.793], p=0.04). Conclusion: Among identifiable risk factors, only lower body mass index was the independent predictor of post-ERCP pancreatitis. Keywords: Endoscopic retrograde cholangiopancreatography; Pancreatitis; Risk factor
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Introduction
The British Society of Gastroenterology (BSG) guidelines state that “Urgent therapeutic ERCP should be performed in patients with acute pancreatitis of suspected or proven gall stone aetiology who satisfy the criteria for predicted or actual severe pancreatitis”. The Cochrane review in 2012 suggested that ERCP does not affect morbidity and mortality and some patients with gallstones in the CBD will pass spontaneously.Aim
The aim of this study was to assess predictive factors of mortality and the need for ERCP in severe gallstone pancreatitis.Method
Data for patients who presented with acute severe biliary pancreatitis between January 2012 and April 2014 was collected. Data collected included predicted severity (Modified Glasgow score), liver function tests, white cell count, USS, ERCP and MRCP reports. Overall 90 day mortality was also recorded.Results
123 patients had predicted severe pancreatitis. On US 21 patients had a dilated CBD and 16 had CBD stone. 51% of patients (n = 63) had MRCP of which 22 patients had CBD stones. 60 patients had ERCP. In 17% (n = 21) no stone was found. 2 patients (3%) developed post ERCP pancreatitis.11% (n = 14)of the patients admitted with predicted severe acute pancreatitis died. On univariate analysis albumin (p = 0.003), alanine transaminase (ALT) (p= <0.05) but not ERCP was significant in predicting mortality. High white cell count demonstrated a trend towards predicting mortality (p = 0.08) but did not reach statistical significance. On multivariate analysis albumin (p = 0.41) and ALT (p = 0.005) retained statistical significance.Conclusion
Low serum albumin and ALT predicts mortality in severe GSP but ERCP does not and may precipitate further attacks of pancreatitis. Patients who have severe gallstone pancreatitis without deteriorating LFTs or cholangitis should have an MRCP to confirm stones in the CBD prior to ERCP.Disclosure of interest
None Declared.Univariate analysis
White blood cell
Aspartate transaminase
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In most cases, endoscopic retrograde cholangiopancreatography (ERCP) is a safe procedure. However, acute pancreatitis is the most common complication with an average incidence of 4-5.5% and a mortality of 0.5%. Aim: The present study aims to evaluate the incidence and the risk factors of post-ERCP pancreatitis (PEP). Material and methods: Patients who underwent first-time ERCP for choledocholithiasis were included in a prospective, single center trial. Results: The study group consisted of 98 patients (53 women - 54.08% and 45 males - 45.91%) with an average age of 63.56 ± 14.09 years old, without statistically significant differences between genders. From the 98 patients enrolled in the study, 8 patients (8.16%) developed acute pancreatitis manifested clinically after the interventional procedure (6 patients with mild - 75% and 2 with moderate forms). No severe cases have been recorded and in all the cases the evolution was rapidly favorable. Risk factor analysis demonstrated that 77.6% of the patients enrolled in the study had at least one risk factor for PEP. All patients who developed PEP (8 patients) were females; no cases of post-ERCP pancreatitis have been reported in patients under the age of 60; among the patients who developed PEP, 4 of them had normal serum bilirubin and the other 4 had hyperbilirubinemia; 66.7% of patients with excess contrast were diagnosed with PEP. Conclusions: The incidence of acute post-ERCP pancreatitis in our study was similar to the one reported in the literature. No severe pancreatitis was recorded, and the progression of the cases with pancreatic complications was rapidly favorable. Out of the risk factors associated with the occurrence of acute post-ERCP pancreatitis, only female sex and excess contrast substance correlated with PEP in the patients of our study.
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Abstract Endoscopic retrograde cholangiopancreatography (ERCP) is an effective tool in the diagnostics and treatment of bile duct diseases. Although minimally invasive, the procedure is associated with a risk of complications, with acute pancreatitis being the most serious. In recent years, high hopes have been placed on pharmacological prevention of acute pancreatitis after ERCP. The aim of the study was assessment of the efficacy of low-molecular-weight heparin and somatostatin in combination with diclofenac in the prevention of acute pancreatitis after ERCP. Material and methods. The study enrolled three groups of 30 patients diagnosed with cholelithiasis; group I: patients who received low-molecular-weight heparin prior to ERCP, group II: patients who received somatostatin and diclofenac, group III: control group. The study assessed the incidence of acute pancreatitis, hyperamylasemia and increased CRP levels. Results. Acute pancreatitis was observed in 13.3% of group I patients, 10% of group II patients and 16.7% of group III patients (no statistical significance). Hyperamylasemia was observed in 16.7% of group I patients, 16.7% of group II patients and 43.3% of group III patients. These differences were statistically significant. No significant differences were found in the occurrence of increased CRP levels among the study groups. Conclusions. No significant reduction in the occurrence of acute pancreatitis after ERCP was observed in patients who received pharmacological prophylaxis. A significant reduction in the occurrence of hyperamylasemia was found in drug-treated patients.
Hyperamylasemia
Diclofenac
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To explore whether there is a difference in the frequency of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in patients with manometrically confirmed sphincter of Oddi dysfunction (SOD) types I, II, and III.A retrospective review of all of the patients who underwent an ERCP with SOD type I or patients with manometrically confirmed SOD type II or type III (mean basal sphincter pressure ≥ 40 mm Hg) from 2006 to 2010 was performed. The primary outcome measure was development of post-ERCP acute pancreatitis in each of the SOD groups. Factors associated with acute pancreatitis in each group were examined by univariate analysis.We identified 147 patients with SOD. Biliary sphincterotomy was performed in all of the patients, and pancreatic sphincterotomy was performed in 68 of the 147 (46%). All of the patients underwent stenting of the pancreatic duct. Post-ERCP pancreatitis occurred in 23% of the study cohort. Patients with SOD type III had a higher frequency of post-ERCP pancreatitis compared with the SOD type I and type II groups (31% vs 20% vs 6%, respectively; P = 0.024). Those with SOD type III had a greater frequency of post-ERCP pancreatitis (odds ratio 6.7; P = 0.05) compared with those with SOD type I. Patients with SOD type III had a two times greater frequency of developing post-ECRP pancreatitis compared with those with SOD type II.SOD type III is strongly associated with the development of post-ERCP pancreatitis compared with SOD type I.
Univariate analysis
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